The photo shows the right eye of a 77-year-old male who has developed a circular area of desiccation on his superior-temporal cornea. The patient had previous laser-assisted in situ keratomileusis (LASIK) surgery OD and OS with secondary epithelial ingrowth, which resulted in surface irregularity and decreased best-correct visual acuity. The patient was successfully fit with scleral contact lenses.

At this follow-up appointment, an air bubble was noted under his right scleral lens (Figure 2). The persistence of the bubble resulted in corneal desiccation that is evident with fluorescein staining. Application bubbles are a common occurrence with scleral lens wear. Small mobile bubbles typically are of no clinical consequence. The danger of persistent bubbles is that they can chronically dry the surface, resulting in epithelial breakdown. Chronic exposure to a persistent bubble could lead to corneal thinning.

The patient was re-educated about proper application techniques and to visually check for bubbles. Instructing patients to overfill the bowl of the lens and to clear the lid margin will reduce the occurrence of application bubbles.